Provider Demographics
NPI:1619156908
Name:JOSEPH A. MOTTO, MD
Entity Type:Organization
Organization Name:JOSEPH A. MOTTO, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-443-3524
Mailing Address - Street 1:PO BOX 23503
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37422-3503
Mailing Address - Country:US
Mailing Address - Phone:423-842-5260
Mailing Address - Fax:423-899-5632
Practice Address - Street 1:4355 HIGHWAY 58
Practice Address - Street 2:SUITE 107A
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-2939
Practice Address - Country:US
Practice Address - Phone:423-842-5260
Practice Address - Fax:423-899-5632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000014144207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529928040Medicaid